Provider Demographics
NPI:1215400049
Name:DAENZER, DUSTIN JERRED
Entity Type:Individual
Prefix:MR
First Name:DUSTIN
Middle Name:JERRED
Last Name:DAENZER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17653 PEAK AVE
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-4126
Mailing Address - Country:US
Mailing Address - Phone:408-856-5829
Mailing Address - Fax:
Practice Address - Street 1:17653 PEAK AVE
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-4126
Practice Address - Country:US
Practice Address - Phone:408-856-5829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst